Hello. I'm a foreign medical graduate, licensed in another country, US Citizen, interested in pursuing a career in nursing. I've heard that you can "challenge" the NCLEX, meaning that you can take it and get licensed without any formal nursing education (bachelors, associate degree). Is there any truth to this? Thank you for your time.

- Marissa

Answer:

Great question! Can a United States citizen with a foreign non-nursing degree (in this case, an MD) challenge the NCLEX without a formal education in nursing specifically? The answer depends largely on where you wish to practice, as each state board of nursing has its own NCLEX eligibility guidelines.

Most state boards of nursing require candidates for NCLEX-RN (registered nurse) licensure by examination to have a CGFNS Certificate. CGFNS certification is designed specifically for first-level general nurses only (i.e., those applicants who are already practicing registered nurses in another country and who received a formal nursing education outside of the United States). CGFNS certification entails a thorough credentials review of foreign education, licensure and registration, a qualifying exam and, in some cases, the TOEFL exam for English proficiency. Therefore, it is not likely that a foreign-educated MD would be able to take the NCLEX-RN to obtain licensure as a registered nurse.

You may, however, be eligible for NCLEX-PN (practical nurse) licensure by examination. If the state you wish to practice in allows it, you will need to utilize the CGFNS Credentials Evaluation Service. The CES evaluates the educational and professional credentials of a variety of healthcare professionals. The CES will review your credentials and provide a summary report to your designated state board of nursing. The state board of nursing will then make a decision regarding your eligibility to sit the NCLEX-PN and become licensed as a practical nurse.

For more information on the Credentials Review Service, visit the CGFNS website. To find out if your state utilizes the CES for LPN licensure consideration, contact your state board of nursing. Good luck!

I was a CNA in a nursing home Kansas a little over 2 years ago. Now I am working with handicapped adults. I would like to get back in to being a CNA and was wondering how I could do that with out having to go through classes again. Please let me know as soon as you can. Thank you!

Stephanie

Answer:

I checked with the Kansas Department of Health and Environment, which awards certification for nurse aides and maintains the state registry. According to Federal regulation, a nurse aide who has not performed nursing or nursing-related services (via verified employment) for a period of 24 consecutive months must be removed from the state nurse aide registry. As such, you are currently ineligible for employment as a CNA.

You can be returned to eligible status without taking another CNA course, however. A potential employer may elect to perform a skills competency check using the HOC Skills Competency Checklist for Employment Verification. Using this method, a registered nurse at the facility you wish to work for will need to evaluate your performance on each task on the checklist. If you complete all of the tasks in a satisfactory manner, the RN will sign and date the form, then send it to the HOC to update your eligibility status. At that point, you will be eligible for employment again as a Certified Nurse Aide. Best wishes to you as you return to the CNA field!

I am scheduled to have a nursing school interview later this month and I'm a little nervous. What can I do to prepare? What should I expect during the interview?

- Dana

Answer:

It's understandable that you feel nervous about your interview. The good news is, there are things you can do to prepare that will calm your worries and boost your confidence:

1. Review typical questions that may be asked of you during the interview and practice answering them. Mentally rehearsing how you would like to respond will help you feel more prepared and positive on the day of the actual interview.

2. Make a list of questions to ask your interviewer. When you researched the nursing program prior to applying, were there any areas you would have liked to have more clarification on? The interview is your opportunity to ask, and it also shows your interest in the program.

3. Prepare an extra copy of your resume, transcript and application. Bring these with you to the interview in case you need to refer to them.

4. Plan out what you will wear. First impressions do count, and you will want to look polished and professional. Additionally, looking your best will help you feel more confident.

Finally, get a good night's sleep before the interview, and eat a healthy breakfast. You want to be at your best on interview day.

During the interview, you can expect to the interviewer to go over program information with you, sometimes in conjunction with a tour of the facilities. The interviewer will have a list of questions to ask you, and he or she may take notes while you respond. Typical questions include:

* What qualities and characteristics make a good nurse?

* What qualities can you bring to the nursing profession?

* Why did you decide to go into nursing (or, why do you want to be a nurse)?

* What do you consider to be your strengths?

* If there were one thing you could change about yourself, what would it be?

* What are your career goals?

You may also be asked about your volunteer experiences, extra curricular activities and healthcare experience. Don't be afraid to talk about your accomplishments.

The best advice I can give you is to be yourself during the interview. Remember to be positive, smile, make eye contact and - most important of all - relax! You will do just fine!

I have a good friend in my class who is making me crazy! She never does her work, and always hits up the rest of us for answers to homework questions right before class. Instead of taking her own notes, she asks to "borrow" ours. I really like her as a friend, but why should she get good grades without putting in the time and effort my classmates and I do? Grrr!

Nina

Answer:

There will always be at least one person in class looking for a free ride. I understand your exasperation. You work hard for your good grades, and it is not fair that a student who does not put in the effort is being equally rewarded. In fact, it is amazing that a student who is not doing her work is getting high marks in nursing school, which leads me to wonder two things:

1. Why do you continue to share your answers and notes with her, perpetuating the situation?

2. How does this affect your education?

If her persistent requests for homework answers and notes are leaving you frustrated and angry, why not say no? Continuing to enable her is not in anyone's best interests. It can be hard to confront someone who you are close to, but you need to set your limits in this case and be assertive. Explain to her that you value her friendship and want to be supportive, but she will need to do her own work.

My second question for you was how does this situation affect your education? In truth, it should not. You are in nursing school to learn how to be the best nurse you can be. You put significant time and effort into your studies not only to get good grades, but because you understand you need to know all the information presented to you. Once you graduate, it will be your license, your career, and your patients' lives on the line if you have dropped the ball. Have you learned all the material? Have you spent enough time on your studies? Have you done all your work? If so, then you are doing exactly what you need to do to meet your goals, and you should be proud of yourself. Your friend's poor study skills will catch up with her - hopefully sooner rather than later - but the person you need to be concerned with most is you.

My point here is to help you steer clear of toxic emotions that may end up affecting your education. Set boundaries with your friend, and then let go of any negative emotions you have been holding onto. Channel your energy back into your own studies so you can get the best education for your money. You are a good student and you will make a great nurse. Don't let your friend's actions distract you from your true goal - to learn to be the best nurse you can be. Keep up the good work!

Is there such a thing as medical-surgical specialization? If so, how do you get an application for the certification test?

- Josh

Answer:

Yes, there is such a thing as medical-surgical specialization in nursing. Sometimes referred to as the forgotten specialty, medical-surgical nursing is a challenging, fast-paced field filled with variety - there is just no telling what each shift will bring. It is because of this variety that many new grads are counseled to get at least a year's experience on a med-surg unit - there is no better place to hone your skills and get experience with a wide variety of diseases, conditions and treatments. Medical-surgical nurses, with their vast knowledge and skills-base, are the unsung heroes of the hospital setting. Nurseweek has a great article about medical-surgical nursing called A Walk on the Wild Side, which will give you further insight into this area of practice.

In this vital niche, certification can be earned as a Clinical Specialist in Medical Surgical Nursing. The American Nurses Credentialing Center (ANCC) determines eligibility guidelines, administers the national examination and awards certification.

I took the NCLEX exam on 11/27 and I am in a stupor over my exam questions. The test I took was not representative of what I learned in my nursing program. I could not have passed unless by fluke. Half of the time, I felt like I was guessing. I am very depressed about this test.

- Karen

Answer:

Don't give up on yourself yet! The NCLEX was designed so that everyone who takes it will get exactly 50% of the questions wrong and 50% of the questions right. It works kind of like this:

If you get question #1 right, the computer says to itself, "That one was too easy for her...let's give her something really hard."

You get question #2 and it's way over your head. You have no idea what to choose and get it wrong. The computer says, "Okay, that was *too* hard," and it gives you another question that is easier.

It goes back and forth like that, throwing out questions covering all the test plan areas, easier and harder, back and forth, until it can narrow down and reasonably figure out what your competence level is on the continuum. If your competence level is above a

certain mark, you pass. If it is below, you do not.

So, basically, everyone comes out of the exam feeling certain that they failed, because they know they got a lot of questions wrong (the truth is, everyone will get exactly 50% wrong). Passing is not based on how many you answered correctly then, since everyone answers 50% correctly. Passing is based on the challenge level of questions you answered correctly.

I know you are feeling badly about the exam, but I think there is a very good chance you did pass. Hang in there, don't give up hope yet!

I am looking for information on correctional nursing. Are there any special educational requirements? What do corrections nurses do?

- Anne Marie

Answer:

Correctional nursing is a rapidly growing specialty in the profession that offers nurses a high level of autonomy and rewarding practice. Those who do well in correctional nursing have excellent critical thinking and assessment skills, are able to make decisions independently, and have solid interpersonal skills. They are also assertive, empathetic and able to provide care objectively when serving this special population.

What do correctional nurses do? On a given day, they may:

* Conduct physical and psychiatric assessments to new inmates, making appropriate recommendations

* Administer care and treatment to patients on the sick call list for a variety of acute illnesses and chronic conditions

* Respond to emergency situations

* Provide patient education to individuals who may have never had access to healthcare services in the past

The biggest misconception about corrections nursing is that it is unsafe. In truth, working in a correctional facility may be safer than working in the ER. What's more, this special niche in nursing offers a level of professional autonomy rarely seen in other areas.

Correctional nurses may complete a 2 or 4-year nursing degree program and become licensed as RNs, although there are also a good number of opportunities for LPNs working in this fascinating field. Correctional nurses may also seek to attain CCHP (Certified Correctional Health Professional) designation.

The CCHP exam is administered by the National Commission on Correctional Health Care (http://www.ncchc.org/). To qualify for the exam, an applicant must have worked in a correctional healthcare setting for 3 years and provide 3 letters of reference. The exam is open to physicians, nurses, and other healthcare providers working in corrections. The National Association of Correctional Nursing (http://www.correctionalnursing.org/) is also developing a credentialing program specific to nurses to promote quality standards and give professional recognition through certification.

Correctional nursing is a rewarding field offering challenging work and much professional satisfaction. Best wishes for a successful career in this field!

I am having a hard time in a couple of my classes with memorization - there is just so much to learn! Do you have any tips to help me out?

Lynnie

Answer:

For straight memorization, the best technique I have found is to create mnemonics. Mnemonics are aids for remembering information that is otherwise difficult to recall. It involves creating an easy-to-remember cryptogram, silly phrase or rhyme that will help you recall a larger or more complex body of information.

For example, if you need to memorize the order of the basic steps for resuscitation, you could use the mnemonic ABCDE (airway, breathing, circulation, drugs, environment). Another example is this rhyme for treating a person who has fainted: "If the face is red, raise the head. If the face is pale, raise the tail." Need to remember the order of those pesky cranial nerves? Try this goofy phrase: "On old Olympus' towering top, a fat, vain goblin viewed a hop." The first letter of each word in this jingle corresponds, in order, to the first letter of each cranial nerve (olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory and hypoglossal).

Mnemonics are fun, easy to remember, and best of all - they've been used by students in medical schools for decades. Most likely, if you are having trouble with a particular topic, someone else did too and a handy mnemonic has already been created.

Visit the MedicalMnemonics.com (http://www.medicalmnemonics.com) for the most comprehensive database of medical mnemonics on the net - they've got a mnemonic for everything! You can search by keyword or just browse by category. Another great resource is MD4sure.com (http://www.md4sure.com). This site has mnemonics concerning the basic sciences, medical conditions, etiologies, signs and symptoms, diagnoses, and therapies that can easily be remembered. They also have a handy list of medical acronyms and shorthand.

I am a nursing student and am thinking of becoming a nurse epidemiologist. After getting my RN, do I need further training? Where can a nurse epidemiologist find work? Any related information would be helpful. Thanks!

Electra

Answer:

Epidemiology is a fascinating field that focuses on the population perspective of healthcare and disease prevention. Have you read any articles recently on antibiotic-resistant bacteria, outbreaks of Dengue Fever or anthrax cross-contamination? Chances are a nurse epidemiologist was on the case, working with other healthcare professionals and scientists on research, tracking and control measures.

Most nurse epidemiologists complete a Master's Degree in Public Health (MPH) and may also seek to acquire certification in infection control. Infection control certification requires current licensure as an RN and a minimum of two years' experience working in an infection control or epidemiology-related position (for more information, see the Certification Board of Infection Control and Epidemiology at http://www.cbic.org).

Nurse epidemiologists study the distribution and dynamics of disease in population groups, evaluate the efficacy of healthcare programs and conduct clinical research. They monitor hospital and community-acquired infections, watching for clusters, and advise on infection control procedures and protocols. They are employed by hospitals, healthcare organizations, public health departments and community health organizations.

The American Nurse ran a great article offering an insider's view of this clinical specialty. "On the Superbug Front," which chronicles Barbara Russell's 25-year career as a nurse epidemiologist, can be read online at: http://www.nursingworld.org/tan/99novdec/nursspec.htm

I hope this information helps as you plan for your education and career as a nurse epidemiologist - best wishes to you!

Hello, I am really "stressed out over nursing school" because I am having problems with pharmacology dose calculation problems. I have the basic idea, but am having difficulty with pediatric dose calculations more so than other concepts. Do you have any information on videos that are available with step by step basic instructions. I really enjoy using ratio to proportion and it helps a lot with basic problems. Thanks, and have a beautiful day!

Lisa

Answer:

I checked with the major nursing education publishers and the only video support materials I found for dosage calculations were designed for classroom instruction. Unfortunately, these materials are cost prohibitive for the average student (roughly $400 per module).

That said, I would imagine your nursing program has a library of support materials you can access for free. These materials typically include books, computer tutorials and videos you can use at your own pace to practice and perfect dosage calculations. Ask your instructor what support materials are available to help you succeed.

Another option is peer tutoring. If you are not already in a study group, join or form one. If there is someone in your class who seems to do well with dosage calculations, ask them for help. They may have a different way of explaining things that will make more sense to you.

Finally, there are some great online resources to help you with your dosage calculations:

This online tutorial hosted by the Alamo Community College District covers common conversion factors and equivalencies, abbreviations, ratios and proportions, IV and titration, and pediatric pharmacology math. Once you have completed the tutorial, there are online quizzes you can take, with automatic grading.

Drug Calculations for Nurses is an excellent shareware program developed by Richard Lakeman. It generates drug calculation quiz questions relating to metric conversions, tablet dosages, fluid dosages, intravenous flow rates and intravenous simulations. Questions are randomly generated based on a database of drugs. Help and solutions are included, as well.

I am currently undergoing my clinical rotation in mental health nursing and would like to know why nurses need to know about a patient's cultural background? Thanks in advance and I look forward to hearing from you.

Sabrina

Answer:

This is an important question and I am glad you asked! As nurses, our job is to assess and care for the needs of our patients holistically. Human beings are multi-faceted. As such, a complex network of interdependent factors jointly form the conditions for health or disease. To be a truly effective practitioner, a nurse needs to plan care that complements and supports the whole patient. This includes an accounting of physical, mental, spiritual, emotional, social, ethnic and cultural influences that collectively impact health.

Understanding a patient's cultural background is important for several reasons:

It improves the communication process. This helps you better understand what the patient is trying to express, and allows you to frame your questions in a manner the patient will understand. For example, a person of Chinese heritage may not be comfortable asking for pain medications. If you are not aware of this cultural trait, your patient could end up suffering needlessly.

An understanding of cultural beliefs about health may help you identify the most appropriate interventions. For example, an anemic patient who is a strict vegetarian will not be compliant with interventions aimed at increasing meat protein intake. More appropriate action would include patient education about the combinations of plant foods that together form complete proteins.

Patient comfort, which contributes significantly to the restoration of health, can be more readily achieved if you are aware of the cultural practices to which the patient adheres. For example, many cultures practice family-sleeping, wherein children sleep in the same bed as their parents. The recovery of a child from this cultural background may be greatly enhanced by allowing parents to stay overnight at the hospital whenever practicable.

The most important thing to remember is that all patients are unique individuals deserving of respect and non-judgmental, quality care. Understanding and respecting cultural differences is an important foundation of your nursing practice. For more information and case studies, I highly recommend the Transcultural Nursing Website at http://www.culturediversity.org.

I hope this information helps - good luck to you in your mental health rotation!

A DNR is a do-not-resuscitate order. If a patient stops breathing or if their heart stops beating, the DNR tells medical professionals they are not to initiate emergency cardiopulmonary resuscitation. It is important to note that the DNR only relates to CPR and does not apply to any other types of treatment or procedures.

In an emergency situation, it is assumed that all individuals would want CPR performed as a life-saving measure. However, individuals with a serious or terminal illness may decide in advance that they do not wish to have emergency CPR. This is because in certain cases, CPR may leave the individual in a worse state than before the procedure was performed. If CPR only partially works, an individual may be left with brain damage or other negative effects that would seriously limit their future quality of life. A DNR is a decision to let nature take its course without heroic interventions.

From an ethical perspective, DNR orders are acceptable when CPR would have a higher physical cost than benefit. Typically, an individual must discuss their health and options with their physician before a DNR order can be entered. A DNR can also be entered in written form via a Living Will, providing that there are two witnesses present. Finally, a DNR can be issued by proxy if you have legally designated another individual to make decisions about your healthcare treatment.

As a nursing professional, it can be difficult to stand down when there is a DNR order in effect, but ethically, the patient's values and choices take priority. Each individual has the right to make personal decisions about their healthcare and we, as healthcare providers, are obligated to respect those decisions.

Can you tell me of websites that have online nursing courses with CEU capability? Courses related to Hospice/Pain Managment would be of greatest benefit. Thanks!

- Karen

Answer:

What a timely question! The Student Nurse Forum just partnered withCEUs4U.com to be able to offer CEUs to nurses. I checked the database of available online courses, and they have several addressing Pain Management (up to 7 contact hours per course).

For hospice and palliative care CEUs, I hunted up the following online providers:

I need information on a nursing care plan for a 4 year old child with reactive airway disease.

- Nichole

Answer:

The most comprehensive resource online for care plans is Careplans.com. They have a vast librabry of sample care plans categorized by problem statements, as well as a message forum. Another resource is theCarepl-l list archives. Use the search function on their website to find what you are looking for, rather than wading through months of posts. Hope this helps!

I recently graduated from a foreign medical school with a preparatory degree in BS Biology. However, I haven't taken the licensing exam for foreign medical graduates yet. I plan to take the review first and while doing so, I would like to get a job as an LVN/LPN. Is there any examination that I can challenge so that I don't have to study for 1 year in becoming an LVN. Please email me back. Thanks.

- May

Answer:

Eligibility to sit the NCLEX-PN is dependent on several factors, one of which is clinical experience. While there are a few states that individually may allow you to challenge the exam without graduating from an accredited LPN program, you would need to provide documented proof of significant clinical experience in a healthcare setting.

I am not sure of the particulars of your background in healthcare, but I would suggest going straight to the horse's mouth. You can contact the folks at The National Council of State Boards of Nursing by calling 1-800-551-1912.

I'm looking for a program in which a hospital pays for your degree in return for several years of working at that hospital. I know this program exists - I just can't find it! Please help!

- Hannah

Answer:

I don't know what state you live in, or where you plan to go to school...but here are a few programs I turned up by entering "nurse education loan repayment" in the Yahoo search engine:

The Nursing Education Loan Repayment Program will repay up to 60% of your student loans in exchange for a 2-year employment contract to work in an approved facility in a rural or urban community with an underserved population and a shortage of nursing professionals. National program.

Comparable programs are offered in New Hampshire and Colorado (see Scholarships page).

I think the type of program you were thinking of is like the one offered by the Mountain States Health Alliance (a large healthcare organization in northeastern Tennessee). They pay for your schooling in exchange for an agreement to work at one of their facilities after graduation for a set number of years.

Hi, I was wondering if you were experienced in the field of Anesthetics at all. If you were and you had some pictures or a website or a person we could call then could you please e-mail me back. If not, I would still appreciate an e-mail saying you don't, so I dont worry about it. If you don't get this before May 7, 2001, then please don't contact me unless its to say that you don't have any resources I could use. By the way, this is for a History Day project.

- Charity

Answer:

Here are some websites with information on anesthetics for your History Day project. The Virtual Museum of Anesthesiology and the Anesthesia History Calendar (see links below) are fun websites with lots of information. Also, you may want to e-mail the American Association of Nurse Anesthetists for information - I am sure they would have some folks you could interview. I have included their weblink below, as well.

I'd like some pointers for getting along with my doctor. I have cleared HBV, but have active HCV for 29 years. My ALT and AST were high (2.5 x national average). Five years ago it dropped to just above normal and stayed there. I'm having HCV symptoms (joint aches, nauseous/vomiting, tenderness and swelling in my right upper abdomen, constantly tired and poor memory.) The GP says no testing for genotype, biopsy, viral load, etc. until I have two ALT and AST tests that are twice the national average.

I live in northern Canada. There are 3 GPs for 10,000 people. I’m the only HCV person in the area. I realize with the high patient load the doctor does not have the time to dedicate to research HCV for just one patient. The closest specialist is a $1,200 plane ride away and I have to be referred by my GP; he’s not willing to refer me until I get the two high tests. Even if he refers me, it may be years until my name comes to the top of the list. I’ve been on a list for almost three years to see a neurologist and this length of time wait is normal here. Any suggestions on how to work with my doctor to get the best medical care possible? Any suggestions on getting the lab personnel to wear rubber gloves when they take blood?

Thanks, Debbie

Answer:

I am so sorry to hear of your frustrations trying to work within the healthcare system to get the tests and treatments you need. Three GPs for 10,000 patients?? I am at a loss for words - but my heart goes out to you. Don't be afraid to be your own advocate - you deserve quality care and respectful consideration.

This forum was designed to answer questions nursing students have related to education and nursing practice. I am not comfortable with, nor qualified to give out medical advice regarding your condition. HOWEVER, I do have a great resource for you and some advice from our panelists regarding the doctor-patient relationship and protective gloves.

I came across the following gem of a website in my research. It was developed by a Canadian HCV sufferer and includes her personal story of navigating the system, fellow heppers' stories, medical resources, e-mail lists, support groups, Hep C links and alternatives.

I spoke with several Canadian nurses where I work. They both indicate that the Canadian health care system is a tricky one. They felt you could possibly change doctprs, opting for one who would make the appropriate referrals, but again, it could take years for the specialty care - no one gets into a specialist without a referral from a GP. They suggested perhaps going to Toronto where there were more doctors. Also, the question about drawing blood with no gloves - universal precautions are in effect in Canada, so perhaps it was the particular lab. You should request (for your protection as well) the use of gloves as it is a standard of care.

Hi Debbie, The following is written assuming that you do NOT want to move to an area where you can more easily access the proper healthcare facilities and professionals. I will emphasize that if your health is a concern for you, you should NOT be satisfied with a three year wait to see a specialist!!!!!!!!! Wow! The doctors must have a tremendous load up there, eh? 10,000 patients! I have a feeling that you should keep a notebook or a dairy on your interactions with your doctor, your lab results, your signs and symptoms, changes in your health and emotions, etc. Remember to add dates and times. That way, when you speak with your doctor (who may or may not remember you) you have tangible evidence to show him/her about how your health has been and how your appointments have been going. They may not have the time to read all of your chart as they should. Feel free to jot down some latest information and research on your illness. Be prepared. Refer the staff to articles that will educate them about HCV so that they can protect themselves by using universal precautions (rubber gloves, etc.) when they treat you. Take care,

The Canadians have a national health insurance program (NHIP), the focus of which is to be cost effective and provide quality care. They believe this can be achieved through prevention and health promotive activities. Consumers (clients), as they are called, are encouraged to participate in their care and collaborate with pprofessionals and non professionals. The health benefits cover a broad spectrum of care except elective surgery. To successfully receive the benefits of this program, the consumers of Canada should focus on prevention care, i.e. routine checkups that are prescibed, and actively speak with health care providers about ways that he or she can achieve the optimal level of health. However, if after speaking with her health provider, she feels her concern are not completely satisfied, I think she needs to go to the person above the health provider for a better response. The Canadian health system NHIP is operated by each provincial government. Contact the administrator in your area to discuss your concerns.

This is my last semester of nursing school and I'm doing a presentation on Reality Shock for New Nurses.I am having some difficulty finding current information about this topic. I would appreciate any information about REALITY SHOCK. Thank you!

- Emily

Answer:

I found three solid resources for you to evaluate as you develop your presentation:

WWW.NewGradProgram.Net

This is a web site designed to provide resource information on developing a nursing preceptorship program, with special focus on new grads or nurses returning to the work field, within an acute care facility. For your purposes, check out the great section on the three phases of reality shock and how to work through them.

This page was desinged to help the energetic "new nurses" who are exchanging the comfort of the school setting for the reality of the work world. Developer Carol A. Tingle, MSN, RN says, "You have heard the term 'reality shock;' workplace advocacy strategies could help you experience 'static electricity' rather than 'electrocution."

This article from the Nursing Times focuses on reality shock for new grads. "The euphoria of qualifying as a nurse and getting your registration can be quickly followed by anxiety, trauma and fear as the struggle begins to make the transition from student to staff nurse. Nurses who have made the move often describe feelings of overwhelming shock when faced with the reality of accountability and responsibility."

I am having trouble finding articles on the effects of the cost of medication and the nurse's ability to assist in patient compliance. Do you know of any websites with articles dealing with this topic? Especially how it affects patients and nurses in urban communities where healthcare financial issues are important. Thanks!

- Anne-Marie

Answer:

Great question! Medication non-compliance, the failure to take drugs on time in the dosages prescribed, is as dangerous and costly as many illnesses. Studies have shown than non-compliance causes 125,000 deaths annually in the US, leads to 10 to 25 percent of hospital and nursing home admissions, and is becoming an international epidemic. It is, in the words of The New York Times, the world’s "other drug problem."

I had a dickens of a time finding quality articles for you that specifically addressed your needs. I did find the following two resources - the first is probably more useful than the second:

Are there any states that do not recognize a two-year associate degree in nursing? I was informed that North Dakota was one, is this true, and are there others?

- Melissa

Answer:

I did some checking, and North Dakota does require a bachelor's degree in nursing in order to be eligible to sit the NCLEX-RN. According to theNorth Dakota Board of Nursing, "successful completion of the baccalaureate degree nursing program is one of the requirements for admission to the registered nurse licensing examination." Additionally, they note that to sit for the practical nurse (LPN) exam, a student is required to have successfully completed an associate's degree nursing program.

This is the first state I am aware of that requires a BSN for RN licensure. There have been efforts for some time now to raise the education requirements nationally to the BSN level, however these changes will be made on a state-by-state basis if they occur. Previously licensed RNs in affected states would be grandfathered in.

I have been unable to locate a comprehensive listing that includes individual state licensing requirements. I imagine this is because state laws change frequently, so such a list would be difficult to keep current. Your best bet is to check directly with the State Boards of Nursing where you intend to practice, to make sure you will meet their prerequisites to sit the NCLEX-RN. A contact list can be found on the National Council of State Boards of Nursingwebsite.

I am currently enrolled in the LVN program at Austin Commuity College and I have to write an ethics paper this semester. My topic is the discrepancy of care between funded and unfunded patients. My question is: where are some web sites to look up info. on this subject?

- David

Answer:

Here are a few good articles to get you started - and there are plenty more where that came from! I typed "nursing ethics uninsured patients" into the search box on Yahoo, if you want to review more material or refine your search.

Fighting Against the Evils of For-Profit Health Care: The Patients’ "Bill of Rights"

I just got enrolled in nursing school for the 2-year RN program. I took my first test and performed poorly. I know I didn't study enough. Will I be able to bounce back in the next 7 exams?

- Balwyn

Answer:

I think part of your answer lies in your original question - you said you know you didn't study enough. It can be difficult at the beginning of school to know what to expect on the exams - how hard will they be? How much of the material will you actually be tested on? How much study time is required to perform successfully on the exams?

The answers to these questions depend in large part on your instructors and their particular testing styles. Until you have had that first exam, it's hard to know what to expect and how to prepare.

Can you bounce back? Absolutely! I don't think there's a nursing student out there who hasn't bombed one of their first exams. Although I know you are disappointed, use this test as a learning experience. Look at the kinds of questions you were asked. Was it primarily short-answer and essay questions? If so, concentrate on having an in-depth understanding of the core concepts. These kinds of questions are usually designed to gauge your critical thinking skills and ability to apply the knowledge to different situations. Were the questions multiple choice, fill-in-the-blank and/or true/false? If this was the case, you will need to beef up on facts and concentrate on memorizing definitions, formulas, rules, etc.

Another thing that will help you prepare for the next exam is your course syllabus. It will list the very information you are required to learn in the class. Use this as a study guide for each section. You can do this by turning course objectives into questions (ex: "student will be able to demonstrate understanding of cell theory" becomes "What is cell theory?").

One more thing to hopefully make you feel better...if you have 7 more exams to go, you have plenty of time to bring your grade up. For example, if you got 60% on this exam, and are able to hit 85% on the next 7, your final grade would be 82% (which is usually a B). Even an A is still possible - so there is hope!

Balwyn, don't give up, and don't be too hard on yourself - trust me when I say that this has happened to everyone at one point. Next time, you will know better what to expect, will be better prepared, and you will be successful! Best wishes as you continue your studies - let us know how you do!

My question is: Is it possible for an LPN to work in Labor and Delivery?

Christy

Answer:

I have found numerous employment listings for LPNs to work in L&D, but have been unable to locate any source material outside of classified ads to back this up. I am assuming an LPN can work in L&D, just as a tech or CNA can work in L&D - it is the scope of practice that is the issue. Regulations will vary from state to state - check with your state board of nursing. Read on for advice and insight from our nursing panel members...

In response to the nursing student wanting to know if LPNs could work in L&D, under New York state law, the only limitation is that LPNs cannot do an initial assessment. I have seen LPNs in L&D - their practice is comparable to the RN. However, the RN is reponsible for new admissions, as well making a

COULD an LPN work in L&D? I guess that depends on her level of experience and comfort with the role. I am sure an LPN is just as trainable as a BSN or ADN, however she may require some additional background education. Also, finding a posted job in that area may be more difficult. LPNs normally can not start IV's and give IV/IVP medications. I am not exactly sure what other limitations they may have. My opinion is: WE set limits for OURSELVES. Any determined person can get a job doing anything they love!

Hi, I am a sophomore at Phoenix College in Arizona. I am now finishing up my prerequisite courses before applying to the nursing program.My true desire is to work as a nurse in a hospice facility. But I dont know what education or degrees I should focus on getting. Do you have any info or advice?? I would be so very grateful. Thanks so much for your time.

- Trisha

Answer:

I applaud your decision to go into hospice nursing. Often called "midwives for the soul," hospice nurses form a unique niche in the nursing spectrum. For one thing, all of their patients die - a difficult reality that can be hard emotionally on caregivers. However, when the body cannot be healed, hospice nurses set about healing the heart and soul, while easing the pain of the body during the final stages of a terminal illness. Hospice nurses neither prolong life, nor hasten death - they help their patients find dignity and peace, and help loved ones by counseling them through their grief. For those truly called to hospice, the work is both an honor and a privilege. Hospice workers help the dying and their families walk together through one of life’s most deeply meaningful and moving experiences – the end of life.

Hospice is one of the last remaining areas of nursing that stands true to the original tenets of the profession, before the advent of managed care. Hospice nurses have the luxury of increased one-on-one time with their patients and families, as well as much lower patient ratios. This allows the hospice worker to provide truly holistic care for the whole person - not just the immediate presenting symptom or crisis.

Like many other nursing specializations, hospice and palliative care nurses can elect to pursue the required education, work experience and testing to receive specific certification in their area of expertise. CHPN (Certified Hospice and Palliative Nurse) is the designation for hospice nurses.

To be eligible to sit the CHPN certification exam, you must be a currently licensed registered nurse with two years' experience in hospice and palliative care nursing practice. You are on the right track already in pursuing your degree and RN licensure.

According to the Hospice and Palliative Nurses Association, "certification is a process through which the National Board for Certification of Hospice and Palliative Nurses (NBCHPN) validates an individual Registered Nurse's qualifications and knowledge in the specialized area of hospice and palliative nursing practice. Candidates who successfully pass the Certification Examination for Hospice and Palliative Nurses are eligible to use the registered designation CHPN (Certified Hospice and Palliative Nurse ) after their names and will receive certification from the NBCHPN."

The benefits of the CHPN credential include proven competency in the hospice and palliative care nursing spectrum, an increased knowledge base for practice, and a demonstrated commitment to this specialty area.

For more information, visit the Hospice and Palliative Nurses Association. Best wishes, Trisha, as you work to complete your education and embark on a career in hospice nursing. If I can be of help or support along the way, please let me know!

Hi..I am looking to pursue an ADN. I live in Massachusetts and was wondering if you know of any good pre-nursing programs in this area?

Leah

Answer:

I cannot personally recommend any programs from MA (since I have not gone to school there), but for the ADN, check out your local community colleges. They offer comprehensive ADN programs that are very cost-effective. You can also go to your local university, but the cost will be significantly higher.

For listings of accredited programs in Massachusetts, visit the following sites:

I will be graduating from Ohio State University this June with my BSN and RN. What are the current salary ranges for new graduates seeking employment in hospital settings such as Med/Surg units and Critical Care Units?

Amy

Answer:

The average national starting salary for RNs is $30,000/yr. The national average for Critical Care RNs is $19.45/hr, and $18.80/hr for Med/Surg. In Ohio, the mid-range for RNs, according the Bureau of Labor & Statistics, is between $15.95-$21.69 per hour (or $33,200 - $45,100 annually). As a new grad, you would most likely be hired on at the lower end of the average for Ohio. Critical Care tends to pull more income than Med/Surg, but you may need to work one year of Med/Surg before training for a critical care unit. For more information, contact a recruiting firm in your area - they should be able to give you starting salaries and experience requirements specific to you region. Hope this information helps!

Hi! I am interested in the nursing field, but I am a little confused about the difference between an RN and an LPN. Can you explain that for me, and also the educational requirements for both? Thank you for your time.

Barbara

Answer:

Here's the short answer for you: Both LPNs and RNs are considered "nurses", and both are required to pass a licensing examination after completing an accredited nursing program. The difference between the two is in the scope of practice and responsibilities, as well as in the required level of education. LPNs require 1 year of education in a state-approved program, while RNs require a 2 or 4 year degree. Both provide basic nursing care, but RNs have an increased scope of practice and responsibility, may supervise LPNs, have higher earnings, and have greater opportunities for advancement.

A final note, both LPNs and RNs are highly skilled, trained nurses. Both are equally deserving of our respect and admiration for their hard work, clinical expertise and compassionate care. LPN programs may be shorter in duration, but they are no less challenging or comprehensive. LPN, 2-year RN, 4-year RN, advanced practice RN - hey - we're all on the same team. I applaud everyone called to the profession, no matter how they got there.

I would like to know the average salary for a crna, how many years they have to go to school, and schools that offer this program near me. I live in Louisville, Kentucky. Thank you very much for taking time out of your busy schedule to answer my questions!

Melissa

Answer:

CRNA's (Certified Registered Nurse Anesthetists) are advanced clinical practice nurses who specialize in delivering anesthetics to patients in a variety of healthcare settings. CRNAs deliver more than 65 percent of all anesthetics nationwide. As independently licensed health professionals, CRNAs are responsible and accountable for their practice. Reflecting this level of responsibility, CRNAs are one of the best paid nursing specialties: the reported average annual salary in 1997 was approximately $87,000.

According to the American Association of Nurse Anesthetists (AANA), in order to be a Certified Registered Nurse Anesthetist one must:

1. Hold a Bachelor of Science degree from an approved school of nursing and hold current state licensure as a registered nurse, plus have a minimum of one year of acute care nursing experience.

2. Graduate from a graduate-level accredited nurse anesthesia educational program. The nurse anesthesia educational program will include 24 to 36 months of graduate course work including both classroom and clinical experience with

The major clinical component provides experience with a variety of anesthesia techniques and procedures for all types of surgery and obstetrics. All nurse anesthesia education programs offer a master’s degree. Depending on the particular program, the degrees are in nursing, allied health, or biological and clinical sciences.

3. Successfully complete the certification examination administered by the AANA Council on Certification of Nurse Anesthetists.

As far as accredited nurse anesthetist programs in Kentucky, the AANA only lists one available program:

Can you give me a simplified version of hemodynamics, I need a grasp of it for critical care nursing in school?

Paula

Answer:

Hemodynamics is the study of the dynamic behavior of blood and is the branch of physiology dealing with the forces involved in the circulation of the blood. Traditionally, because pressure is easier to measure than flow in the cardiovascular system, it has been pressure which has undergone the more intensive study.

"As blood flows from chamber to chamber, as valves open and close, and as the myocardium contracts and relaxes, pressures are generated in various parts of the heart. These cardiovascular pressures can be measured and monitered through catheters whose tips are placed in the atria, pulmonary artery or systemic arteries. These are called "hemodynamic lines".

"Hemodynamic lines have several uses. They enable you to sample venous and arterial blood without having to stick a patient over and over. They provide a way to monitor various waveforms, which can provide clues to patient status. The combination of pulmonary, arterial, and systemic arterial lines can be used to calculate cardiac output. Most important, these lines enable you to monitor directly various cardiac pressures. Interpretation of these pressures can guide you and the physician in planning and evaluating therapy in shock, fluid overload or deficit, cardiac failure, and other conditions." (CyberNurse.com - Cardiac Hemodynamics. See link below).

I would like to know what the average salary is right now for a registered nurse and how many years it takes to become a nurse? I would really appreciate it if you answered my questions.

Jessica

Answer:

According to the most recent report from the Bureau of Labor & Statistics, the median annual earnings of registered nurses were $40,690 in 1998. The middle 50 percent earned between $34,430 and $49,070 a year. The lowest 10 percent earned less than $29,480 and the highest 10 percent earned more than $69,300 a year. Median annual earnings in the industries employing the largest numbers of registered nurses in 1997 were as follows:

Personnel supply services

$43,000

Hospitals

39,900

Home health care services

39,200

Offices and clinics of medical doctors

36,500

Nursing and personal care facilities

36,300

In addition to salary, many employers offer health and other insurance benefits, flexible work schedules, child care, educational benefits, and bonuses. The average salary will be higher in larger cities, lower in rural areas.

Currently, to become a registered nurse, you must complete either a 2-year associate's degree program or a 4-year bachelor's degree program with a nursing major. Once you have graduated, you are eligible to take the NCLEX exam, which, when passed, awards you a license to practice as a registered nurse. Note that there has been discussion of raising the educational requirements for an RN to a minimum of a bachelor's degree - nothing has been passed yet, but it is something to be aware of.

For more information on the nature of the work, working conditions, employment options, required education, training, and other qualifications, job outlook, earnings potential, and related occupations you can investigate (such as LPNs), please visit the following page on this site: Registered Nurses

Let me know if you have additional questions, Jessica. Best wishes to you!

Thank you for answering my previous question, and I hope now to find an answer about this :) I need some info. about ethical nursing care of cancer

- Ameen

Answer:

Good to hear from you again! I think this would be a good opportunity for me to discuss researching on the web. When you need to find information about a given subject, a quick way to zoom in on possible resources is to use a search engine (such as Yahoo, AOL, Lycos, etc.). The search engines look for "matches" in the text of webpages based on the keywords you enter into the search box. For example, if you want to find out about the ethics of nursing care with cancer patients, you would take the major words in your question (ethics, nursing, cancer care) and enter them into the search box. The search engines will match things up and give you a list of websites that have those words in them. Obviously, the more specific you can be, the better your chances of a good match. If you just enter "nursing ethics" you would have to wade through thousands of matches before finding an article related to cancer care. Likewise, if you entered only "cancer ethics, " you would get results relating to ethics for many different professions, not just nursing. Try to be specific in your choice of keywords.

Once you have entered your search, the search engine will give you a list of matches with a quick summary where the words are used on the page. You can read these summaries to quickly determine if a site will provide the information you need. In the case of our example here, one result came back listing two different articles on the same webpage - one relating to nursing ethics in the treatment of children, the other article relating to cancer care. This match, then, would not be what you are looking for, since you want an article that addresses nursing ethics of cancer care specifically. If a result seems like a good match, click on the link and go to that site to review the material.

Using the tools above, you can conduct a similar web search to find exactly the information you need. One more thing to note - always be sure to evaluate the source of the material you choose to use for your nursing projects. An article from a respected medical institution or association will carry more weight than an article from a fringe group or personal webpage, and the information will be more reliable. Hope this helps!

I've had a knee replacement that became infected. It was removed. I had IV antibiotics and the culture came back negative. Can they go ahead with a new implant, and what are the chances of a good result?

- kras2

Answer:

I am so sorry to hear of the complications you experienced after your surgery. While only 2% of knee replacements become infected, it poses a major problem when it does happen. I am glad you have been following the treatment proposed by your physician.

This forum was designed to answer questions nursing students have related to education and nursing practice. The Hippocratic oath says, "first do no harm," and I am not comfortable with, nor qualified to give out medical advice regarding your condition. Knee replacement surgery requires the advice of qualified orthopaedic specialists.

I did find some resources online for you. In the case of any kind of surgery or treatment, meet with your physician/surgeon and don't be afraid to ask them questions - that's what they are there for! Also, get a second opinion. Your surgeon will not be offended. You owe it to yourself to investigate your options and to advocate for your health needs. Here are some links:

Juan Gonzales is a 33 year old Mexican American male who comes to General Hospital Emergency Room with acute appendicitis. He has a temperature of 104, is diaphoretic, and confused. After his emergency appendectomy he is released to the medical-surgical floor of General hospital. His Nurse Bobby Jones reviews his case and develops a plan of care for him...(click on the link below to read the full case study)

In 2005, Emily G., age 8, is brought to her local CLSC by her mother after suffering from abdominal pain for the past 24 hours. Blood tests and an abdominal ultrasound performed by a radiologist suggest appendicitis. An MUHC pediatric surgeon is contacted, the digitized ultrasound is electronically forwarded to a pediatric radiologist, and the diagnosis is confirmed...(click on the link to below read the full case study...it's about halfway down the page on the MUHC website)

Fifty-nine-year-old Sarah was admitted to the hospital with severe abdominal pain caused by a ruptured appendix. She had an emergency exploratory laparotomy and an appendectomy. Approximately one month later, when readmitted for evaluation of recurrent severe abdominal pain, surgeons found multiple abscesses...(click on the link below to read the full case study)

I am wondering if there is a web site that has samples of Process Recordings or if there is a book that can be bought on Process Recording. I would like a good sample to understand exactly what is expected from a Process Recording.

Thank You, Debbie

Answer:

I did a little research on the web and came up with two very good resources for you that should give you an idea of what is expected. Both websites give sample formats and include objectives, directions, etc.:

Where do I go to become a C.N.A.? I live in Pennsylvannia and is there any thing in my area?

Thank You!

Douglas

Answer:

You did not specify where in Pennsylvania you live, so I could not research specific programs, however the first thing I would suggest looking into is training programs offered by local long term care facilities and hospitals. Some have developed accredited certification programs for staff and/or offer on-the-job training. Another option is your local community college. Community colleges are an affordable way to get your certification and usually offer job-placement assistance post completion. Also be sure to check into career training institutes, which have flexible programs sensitive to working adults' scheduling needs. Yahoo has a directory of community and technical colleges in Pennsylvania which may be a good place to start:

Please feel free to write me directly at kcsun3@yahoo.com with more specifics and I will be happy to do a little digging for you. Congratulations on your decision to become a CNA - best wishes for a successful, satisfying career!

Can you provide me with any information about nursing in Saskatoon. What

are the grades that I should have in order to get into nursing and all other important details.

Respectfully yours, Jen

Answer:

The following information comes from the University of Saskatchewan College of Nursing in Saskatoon. They offer a 4-year nursing program, where part-time study is an option. All courses must be completed within 7 years.

"Graduates of the four year program may apply for licensure with the Saskatchewan Registered Nurses Association (SRNA) and/or the Registered Psychiatric Nurses Association (RPNAS). After the third year of the program, students may choose to leave the program with a diploma and apply to register with the RPNAS. The SRNA has stated that in the year 2000 and beyond, graduates must have a degree in nursing in order to be eligible for licensure.

For admission to the NEPS (Nursing Education Program of Saskatchewan) program in the College of Nursing, a student must have completed their secondary standing (24 credits) in Saskatchewan or equivalent, with a minimum weighted average of 65% in the following subjects: English A 30*; English B 30*; Biology 30; Chemistry 30 (Physics 30 is not acceptable as a replacement for Chemistry 30); and, Mathematics at the 30-level. No deficiency is permitted.

* Beginning in 2000, applicants who complete the Fansaskois or French Immersion programs will require two 30-level language arts subjects of which one must be English A30 to meet the requirements.

Cardiopulmonary resuscitation Level C and a Standard First Aid Certificate should be obtained before the start of the program or at the latest by the end of Term 1 of the first year.

Before classes begin, students who are accepted for admission are required to submit an immunization record to the University Student Health Centre."

The program, as in most universities, is selective due to a limited number of spots available per term. Admissions committees will be looking at your grades, any prior experience in the healthcare field (work or volunteer) and extracurricular activitivies.

I have to give a talk to nurses who have just finished their course and would like to talk on the subject of nursing. Could you give me some advice? Thank you!

- Indu

Answer:

Indu, These are excerpts from postings of mine in an e-group I belong to. There may be bits and pieces that you can use in your speech:

When I applied for nursing school, it was the greatest gift I have ever given myself!! I finished the collaborated degree program at Wayne State U. with a BSN in 1996. After working with doctors, I can see that I really was meant to be a nurse. It really is a VERY different profession, coming from a more caring, nurturing viewpoint.

Life happens. As you get older and more experienced, you develop new interests (hopefully). As my mantra goes:"learn, learn, learn!!!

Be open to new things, don't feel that there is any less honor in exposing yourself to new things by changing jobs (i.e. that's HOW you learn!). One of the beauties of the nursing profession is it's multiple aspects - there are so many different kinds of nursing jobs out there!

Nursing school is not the easiest to get through, believe me I know.

Don't hesitate to ask if you don't know anything when you start out on the floor. I have been a nurse for 4 years now and I still learn something new every day. I have learned the most in the ICU. I was absolutely lost when I first started out on med surge, even though I had worked as a nurse's aide and an EMT previously. I thought "What did I do to myself?" and almost gave up because I was terrified every day I went to work. Give yourself time. Trust your instincts. Remember to look at your PATIENT not at the monitors and the lab results, you'll be fine!!

I am trying to get into nursing school. I need to do an essay on my goals and intentions. Do you have any suggestions? Thank you!

- Deb

Deb, I was talking with a nursing school recruiter last month about what kinds of things they looked for in an applicant (outside of a good GPA). One of the things she stressed was they want to make sure an applicant has really evaluated the nursing field and is sure of their decision to become a nurse (with competitive admissions and limited space, they want to admit someone who is dedicated to completing the program!).

From the essay question, it seems they are looking for two things:

How much thought have you put into this? Have you sat down and developed goals for your future career? Someone who is just applying because it sounds like a neat job will not have spent any time looking at this area. Showing the admissions committee that you have a plan for your career lets them know you are committed.

What are you going to do to develop, enhance or otherwise further the nursing profession, i.e. what are you going to give back to the nursing community? By asking about your intentions, they are checking your dedication and vision. Afterall, their goal is not to simply churn out new graduates...their goal is to mentor and develop the future leaders of the field.

The essay is your chance to express *why* nursing is the field for you and what you hope to accomplish as a nurse. It's your best opportunity to showcase your strengths and let your personality shine through, while telling them about your goals. If you take your time with it, write with sincerity and deliver a well-thought out response to their questions, you will have a great essay!

I think if you put your mind to it, you will do great! Many colleges have math resource centers, tutors and study groups you can take advantage of - it helps a lot! The most important thing is your attitude - believe in yourself, work hard, and you will succeed. Keep us posted, and good luck!